Western State Hospital cited for safety gaps; lawmakers look to add staff

Most employees accept that danger is part of the job at a state psychiatric hospital, Dr. Joe Wainer said.

“I’d say I’ve been assaulted about 20-30 times,” said the psychiatrist, an eight-year employee of Western State Hospital. “I’ve been knocked unconscious. I’ve had a chunk of flesh (bitten) out of my shoulder.”

Wainer said the right kind of training for workers can keep their interactions with patients from escalating to that point. He said staff have asked for years for enhanced training, only to be told there were too few workers to cover for someone pulled away for classes.

More staff may soon be devoted to that purpose, after a reprimand from workplace-safety regulators who say Western State Hospital hasn’t done enough to protect its employees from attacks.

The state Department of Labor & Industries issued a citation Jan. 16 for what it labels serious rule violations. It suggested closing gaps in training and security systems.

Now the Department of Social and Health Services says it is nearing a settlement with L&I based on a number of changes the Legislature is considering, mainly focused on more staff.

State lawmakers have already paid for 45 extra staff through June for two safety-related programs at 827-bed Western State Hospital in Lakewood and 287-bed Eastern State Hospital in Medical Lake, and they are poised to extend that funding for the next two years.

The money would pay for teams of staff who respond to emergencies — increasing their ranks at Western State and expanding them to Eastern State — while also creating a ward with a higher staff-to-patient ratio to temporarily house violent patients.

House Democrats included money in their budget proposal for 20 more employees to cover for co-workers getting safety training.

Senate Republicans didn’t include the money in their budget, but the chairman of the Senate mental health committee, Sen. Steve O’Ban, R-Tacoma, said he expects it to be in the final deal.

A settlement in the final stages of negotiations with L&I hinges on all those staff additions, as well as a previously funded expansion of Western State’s security systems, said Victoria Roberts, a DSHS deputy assistant secretary. DSHS also has agreed to pay half of a $5,600 penalty handed down by L&I, Roberts said.

The Service Employees International Union chapter that represents many nurses at the state hospitals said while more staff would improve safety, they should be added to core staffing or a “float pool” of workers that could move between wards, and staff should be paid better to recruit more of them to the understaffed hospitals.

Wainer said the proposed changes have the potential to improve safety, but he contends decisions about safety reforms seem to be made without input from medical staff.

Roberts said the proposals emerged from a safety committee of workers and management that examined more than a decade’s worth of inspectors’ orders and recommendations for common themes.

Roberts said the hospitals are seeing progress.

“One (assault) is too many, but I think the numbers are going down,” Roberts said. “I think having this package in place will further impact (assaults) and make it a safer work environment.”

TALKING PATIENTS DOWN

Employees reported being assaulted 289 times last year at Western State.

That number is lower than in any of the four preceding years. And the rate of staff injury claims as a share of patient population for all three state psychiatric hospitals combined has been on a long-term decline.

Not all attacks are reported, cautions Erika Springer, a nurse at Western State. “A lot of people just live with the little assaults which happen regularly,” she said.

Even on the geriatric ward where she works with more frail patients, Springer worries about what could happen when some of the six people who are supposed to be overseeing 30 patients on her ward scatter to, say, prepare patients’ food or to go on break.

“It can be a little bit scary to look up and realize you’re the only person that’s there,” she said.

There are ways to calm patients to minimize the risk of attacks, other employees say. Nurse Maria Engelhardt-Parales said she has never been assaulted in four years.

Smile, speak softly and give patients suggestions, Engelhardt-Parales said. Are they tired? Do they want to watch a video? Would they like juice? What kind? Would they take their medication with the juice?

“You don’t have to be a Ph.D. to figure out what to do with the patient,” Engelhardt-Parales said. “Most of them feel so lonely, and they just want to be understood.”

Wainer said an employee who earns a patient’s trust can calm that patient. Getting to know each other is more effective than rewards and punishments, he said.

Unfortunately, Wainer said: “When staff get hurt and are untrained, they don’t work to cultivate that therapeutic alliance. They feel fear ... That just results in this escalation of violence.”

Lawmakers are now considering more money for training, but in recent months some annual training has been delayed because of gaps in staffing.

SECURITY UPGRADE

Staffing is not the only problem cited by L&I inspectors.

Staff at Western State carry electronic pendants on key rings or lanyards. When both sides of the device are pressed at the same time, it triggers an alarm on the computer of someone who can broadcast a “Code Green” over the speakers in the area of the employee.

But L&I inspectors noted a dozen buildings or parts of buildings where the system doesn’t work, plus outdoor locations throughout the 763-acre campus.

L&I called for replacing the personal alarm system or expanding it to all areas where employees interact with patients.

Western State has recently expanded the system to several of those buildings, while others would get it if funding became available, facilities coordinator Chris Campbell said.

The hospital has also expanded emergency speakers throughout campus, Campbell said.

Recent years have seen improvements in safety, she said. The hospital has replaced more than 1,000 chairs, beds and tables with pieces of furniture less likely to become weapons — too heavy to pick up or bolted to the floor.

Thousands more new door closers, handles and hinges cannot be used to injure or hang a patient like the ones they replaced.

“We still have a long way to go,” Campbell said. “Unfortunately, it takes money to do all this.”

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